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Dr. Andrew Rynne
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Suggest treatment for hyperventilation syndrome

Answered by
Dr. Seikhoo Bishnoi


Practicing since :2007

Answered : 5175 Questions

Posted on Mon, 29 Dec 2014 in Anxiety and Stress
Question: Hi, I'm a 45 year old male. I have a history of anxiety and panic disorders. Recently, I've developed what my doctor thinks is Hyperventilation Syndrome. Basically, he said that my shortness of breath and dizziness were due to over-breathing. All tests were normal, i.e. blood work, chest x-ray, ECG, Echo-cardiogram, oxygen pulse, and peak flow. Plus, auscultation was normal. My doctor says that to eliminate hyperventilation, I need to slow my breathing down and stop taking such deep, sighing breaths so often.

But I have several other questions, all related to Hyperventilation Syndrome that I forgot to ask the doctor, and I don't really want to go back again right away. So, here they are: Question 1: Does Hyperventilation Syndrome cause exercise intolerance? -- When I first wake up in the morning (after breathing normally all night) I can put on my shoes and take a walk without much trouble. It feels like my lungs are nice and open. But later in the day (presumably after over-breathing) my tolerance for exercise is greatly diminished. My lungs feel full and I get short of breath with just a short walk. Why would this be? Question 2: I don't just have shortness of breath, in general. I also have this weird sensation of needing to take a deep breath. But when I try, I can't seem to do it. I thought that I was just holding too much air in. But even when I make sure to exhale completely, I still can't take a deep breath. However, if I focus on doing slow, diaphragmatic breathing for a few minutes, then I CAN take a deep, satisfying breath. Why is this happening? -- Why would this be? Logically, I would think that if I exhaled completely, I would be able to take in a deep breath, right? Question 3: I researched Hyperventilation Syndrome on the internet and I'm very confused -- i.e. oxygen goes up, carbon dioxide goes down, hyperinflation, residual volume, etc. Please explain this to me a bit, and tell me what I'm doing wrong. I get the whole diaphragmatic breathing versus thoracic breathing, and slowing my respiratory rate down to about 12/min. -- but what exactly causes the problem? -- Should I try to breathe in longer and exhale shorter, or vice-versa. Should I try to breathe out as much as I can, or hold some back? -- Should I breathe out fast or slow? I just don't get what's going on and how to fix it. -- Is my carbon dioxide level going down because I'm breathing out too much or too fast, or because I'm breathing in too deeply, or too fast, or too slow? I'm so confused. Please briefly explain the science behind what's going on. Question 4: I know that the main goal is to slow my breathing down (diaphragmatic) and reduce the frequency of deep, sighing breaths. However, I know that (at least for awhile), I will need to take some deep breaths occasionally. So, if I've put off a deep breath as long as I can, and I really need to take one deep, satisfying breath, how can I do it in such a way that it won't perpetuate my Hyperventilation Syndrome? -- long/short inhale - long/short exhale -- fast/slow inhale, fast/slow exhale, etc. Question 5 (Last one): After I start breathing correctly, how long will it take to get completely back to normal? Are we talking days, weeks, months? I read online that it can take a couple of months, but that information wasn't from a doctor. Thank you in advance for your answers. I must say that, at forty-five years of age, I never thought that I would ever be asking anyone how to breathe! You would think that after forty-five years, it would just come naturally. But, oh well. Thanks again.
Answered by Dr. Seikhoo Bishnoi 2 hours later
Brief Answer:

Detailed Answer:
Hello thanks for asking from HCM

I have read your question and I can understand your problem. You have been diagnosed with hyperventilation syndrome (HVS) and have some doubts regarding the condition. Coming to your queries-

-The basis behind HVS is psychological and physical phenomenon. Due to deep and rapid breathing CO2 washout occurs and this result in change in ph of blood. CO2 decrease cause alkalosis. With alkalosis the red blood cells are not able to deliver oxygen to target organs. Poor oxygen delivery results in fatigue and tiredness, inability to do exercise.

-CO2 and oxygen are two main gases in respiratory system. Increased CO2 cause decrease in ph of blood and acidosis, which result in dissociation of oxygen from Haemoglobin. Decreased CO2 as I have mentioned earlier cause poor dissociation. It is the CO2 which stimulates respiratory centre. Low CO2 fails to stimulate the respiratory centre and individual feels like he is falling short of breathing. Need to take deep breath occur due to poor Oxygen to tissues, but CO2 washout don't allow deep breathing.

-You should inhale longer and exhale shorter. Basic aim is to deliver oxygen to lungs and also to not to loose CO2 from lungs. If CO2 comes down then even in presence of high Oxygen individual will fail to deliver oxygen and will have fatigue. Rapid breathing cause wash out of CO2 and then problem starts. Slow breathing tend to reverse the situation.

-This want of breathing is occurring due to anxiety and stress and you are not feeling relaxed. For some time now if you want to take deep breath you can take once a minute but don't exhale rapidly as it will again precipitate the problem. Our basic aim is to have good inhalation and poor exhalation.

- As proper breathing training is advised to treat the situation and it is not easy to train one individual of dysfunctional breathing so it should take at least a couple of months to see change(like you have mentioned already). The treatment lies in behavioural modification so we don't see quick response but once desired behaviour is achieved individual start improving.

Hope this helps you, I have tried to explain in simple non-technical language, If you want more details and have more doubts you can ask again.


Above answer was peer-reviewed by : Dr. Yogesh D

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